台州地区结核分枝杆菌利福平和异烟肼耐药基因的流行病学调查

蔡莺莺 石庆新 周秋菊 丁仙红 陈佳喜 涂茜 王冬莲

[关键词] 结核病;异烟肼;利福平;耐药基因

[中图分类号] R446.5          [文献标识码] B          [文章编号] 1673-9701（2021）20-0146-04

Epidemiological investigation of resistance genes of rifampicin and isoniazid of Mycobacterium tuberculosis in Taizhou area

CAI Yingying1，2   SHI Qingxin1，2   ZHOU Qiuju1，2   DING Xianhong1，2   CHEN Jiaxi1，2   TU Xi1， 2   WANG Donglian1，2

1.Department of Clinical Laboratory，Taizhou Hospital of Zhejiang Province，Linhai   317000，China;2.Department of Clinical Laboratory，Enze Hospital of Taizhou Enze Medical Center，Taizhou   318053，China

[Abstract] Objective To understand the phenotype of resistance genes of rifampicin and isoniazid of Mycobacterium tuberculosis prevalent in Taizhou area，and to provide evidence for effective treatment of tuberculosis. Methods A total of 482 clinical isolates of Mycobacterium tuberculosis strains sent to and examined in Enze Hospital of Taizhou Enze Medical Center （Group） from August 2015 to November 2020 were analyzed retrospectively.Rifampicin resistance related gene in rpoB， isoniazid resistance related genes in katG and inhA were detected in specificity by DNA microarray chip method. Results In 482 cases of Mycobacterium tuberculosis， 367 cases of rpoB wild type and 115 cases of rpoB mutation-type were detected in rifampicin resistance gene， in which rpoB531（C→T） mutation was the main mutation-type，and 55 cases were detected. 372 cases of katG and InhA wild-type and 110 cases of mutation-type were detected in isoniazid resistance gene. In katG gene mutants， 91 cases were katG315（G→C） mutation and 12 cases were katG315（G→A） mutation. There were only 16 cases of inhA-15（C→T） mutation in inhA gene mutants. In 2020， the resistance rate of rifampicin gene increased to 38.46%， while the resistance rate of isoniazid gene did not increase significantly for 6 years. Conclusion The resistant genotypes of rifampicin and isoniazid of Mycobacterium tuberculosis in Taizhou area is mainly the wild type，but the resistance rate of rifampicin gene is on the rise.

[Key words] Tuberculosis; Isoniazid; Rifampicin; Resistance gene

耐藥结核是全球公共卫生问题[1-4]。2018年全球新增利福平耐药结核病病例约50万[1];其中，我国是全球耐药结核病负担最大的三个国家之一。耐多药/利福平耐药结核病的确诊需要细菌学、痰培养、分子诊断、基因测序等手段[5]。结核病患者确诊后需要接受至少9～20个月的二线抗结核药物治疗[1]，更需要精准的用药指导。通过分子诊断技术检测结核分枝杆菌耐药基因，可快速准确判断耐药情况，提示临床医生根据耐药结果选用合适药物，不仅可以辅助临床选择最佳治疗方案，实行个体化医疗，也可以缩短疗程、降低医疗费用，从而减轻患者和社会的负担[6]。目前，尚无台州地区结核分枝杆菌利福平和异烟肼耐药基因流行病学的分析报道。恩泽医院是台州地区结核病定点医院，标本来源广泛，日常检测量大。